Provider Demographics
NPI:1629112164
Name:CANDLEY, BARBARA A (LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:CANDLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CEDAR BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-0891
Mailing Address - Country:US
Mailing Address - Phone:713-383-0888
Mailing Address - Fax:713-383-0895
Practice Address - Street 1:412 CEDAR BRANCH DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-0891
Practice Address - Country:US
Practice Address - Phone:713-383-0888
Practice Address - Fax:713-383-0895
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01436104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1629112164Medicaid
TX00021HMedicare ID - Type Unspecified
TXE79322Medicare UPIN
TX1629112164Medicaid